Relative potencies of different topical steroids in two serial concentrations were evaluated over the flexor aspect of human forearm in 50 volunteers. The results indicated that the order of potency for different steroid solutions ranged from the lowest with hydrocortisone acetate to the highest with betamethasone dipropionate while other steroids occupied intermediate positions. Further, it was noted that the potency of steroids is enhanced significantly by increasing their concentration.

Seventy six patients having pompholyx of 1 month to 2 years duration were treated with dapsone (DDS) initially with 4 mg/kg/day in two divided doses till clearance of lesions occurred and then with 2 mg/kg/day for a period of 2 weeks. Complete clearance of lesions occurred in all cases in 4 to 18 days (average 7.62 days). Relapse was noted in 4 cases, only one of which required long term maintenance dose for 3 months. A control group of 16 patients were treated with placebo and saline compresses for 3 weeks. Only 3 cases of this group showed clearance of the lesions.

Seven cases of Papillon-Lefevre syndrome from 6 families were studied. Their ages ranged from 3 to 25 years. Falling of deciduous teeth was noticed between 2½ to 7 years. Five patients developed palmoplanatar keratoderma at 3 months of age. Two patients showed punctate lesions also. Only 1 patient was born to consanguinous parents.

A 21-year old man presented with slowly growing, multiple, recurrent, discrete, asymmetrical hyperkeratotic and hyperpigmented papules of size varying between 10-15mm over face and upper limbs; usually after trauma. Histopathology confirmed the diagnosis of reactive perforating collagenosis. This case is reported because of unusual bigger size of the lesions.

A 30-year old man presented with multiple noduloulcerative lesions on right upper limb for 4 years. He had haemorrhagic pleural effusion bilaterally. Histology of skin lesions showed spindle-shaped cells arranged in cartwheel pattern. He died in spite of anticancer chemotherapy.

Kyrle-flegel disease in siblings with childhood onset and koebner phenomenon

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Sanjay Singh, RA Bumb

This is a report of Kyrle-Flegel disease occurring in 3 siblings. Two of them were girls (13 and 9 years) and the third patient was a boy (7 years). They had developed hyperkeratotic papules since the ages of 9, 6 and 5 years respectively. Lesions were present mainly on the extensor surfaces of limbs. Some lesions were linear, they had appeared at the sites of trauma. Histology showed laminated hyperkeratosis, follicular plugging and flattening of the dermoepidermal junction. Patients partially responded to oral vitamin A in high doses.

A 3-year old girl had multiple, large, deep, infected ulcers on the extremities and buttocks for 1½ years. Additional features included malnutrition, Cushingoid facies with buffalo hump, and absence of any underlying bony involvement. Edge biopsy showed a tuberculous picture without vasculitis or acid-fast bacilli; X-ray of the chest revealed military tuberculosis. The ulcers, although atypical, healed completely and rapidly on anti-tuberculous therapy.

A man aged 54 years developed multiple keratoacanthomas with typical histological features over the scalp, face, trunk, upper and lower limbs. History of similar lesions being present in the patient's father and also his son led to the diagnosis of familial multiple keratoacanthomas. Response to oral methotrexate was encouraging.

A 2½ year old boy of meningococcaemia with rare complications like gangrene of the digit, tip of the nose and both helix is reported. Importance of timely suspicion and early intervention with antibiotic to change the fatal course of meningococcaemia is discussed.

A case of systemic sclerosis on long term steroid therapy developed multiple abscesses in the skin and the knee joint. Atypical mycobacteria was isolated from the joint aspirate on two occasions. She responded only partially to treatment.

Three female patients with chronic urticaria and angio-oedema unresponsive to antihistaminics and corticosteroids were found to have moderate to severe depression on psychiatric evaluation. Treatment and follow up using only antidepressants led to complete remission of the skin disorder along with recovery from depression. The importance of detecting an underlying psychiatric disorder in chronic urticaria is highlighted.